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Heme/Oncology > anemias > Flashcards

anemias Flashcards

1
Q

what is Hb level considered to be anemia for menstruating adults, pregnant adults, and male adults

A

menstruating: Hb < 12
pregnant: Hb < 11
male: < 13

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2
Q

average size of RBCs

used to classify anemia as either microcytic, normocytic, or macrocytic, each with its own
differential diagnoses

A

MCV (mean cell volume)

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3
Q

the weight of hemoglobin per red blood cell

A

MCH (mean corpuscular hemoglobin)

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4
Q

indicates the amount of
hemoglobin per unit volume

A

MCHC (mean corpuscular hemoglobin concentration)

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5
Q

assess production of new RBCs
- The “corrected” version takes into account the Hgb level and assesses whether the reticulocytosis is adequate for the severity of anemia
- CRC: reticulocyte % x (Hgb/15)

A

CRC (corrected reticulocyte count)

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6
Q

reflects variation in RBC size and is expressed as a percentage
- Seen on peripheral smear

A

RDW (Red cell distribution width)

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7
Q

a protein that stores iron
- Low levels can indicate iron deficiency
- High levels can indicate iron overload

A

serum ferritin

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8
Q

iron transporter protein

A

Serum transferrin

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9
Q

in iron-deficient conditions, the relative transferrin content compared to iron content increases, and thus, the TIBC values are high (there are open spots that could bind iron but no iron to
bind there)

A

TIBC (total iron binding capacity)

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10
Q

the % of iron binding sites on transferrin that are occupied by iron
- Low saturation means low iron

A

Transferrin saturation

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11
Q

Premature destruction of RBC’s
- Hemoglobin breakdown products retained in blood
- Increased circulating reticulocytes due to increase in erythropoiesis—a
compensation mechanism**
- Increase in serum LDH (abundant in RBC’s)
- Increase in indirect bilirubin -> Jaundice*
- Direct bilirubin may also begin to accumulate -> dark urine
- Decrease in haptoglobin -> bound by free Hb and depleted
- Most are:
- Normocytic*
- Normochromic

A

hemolytic anemia

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12
Q
  • Destruction of RBCs by antibodies that target RBC antigens
  • Clinical signs: typical for anemia, typical for hemolysis
A

Autoimmune hemolytic anemia

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13
Q

how to make diagnosis for autoimmune hemolytic anemia

A

ID of appropriate Ab by DAT (Coombs test)

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14
Q

autoimmune hemolytic anemia treatment (depends on severity)

A
  • Reduction of anemia
  • Prevention of complications like blood clots
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15
Q
  • X linked deficiency of enzyme need to maintain RBCs
  • Clinical signs of hemolytic anemia in neonate
  • Triggered by medications, infections, fava beans
  • Clinical signs of hemolysis
A

G6PD deficiency

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16
Q

how is G6PD diagnosis made

A
  • hemolysis
  • G6PD activity
  • genetic testing
17
Q

G6PD treatment

A
  • avoiding triggers
  • treating anemia as needed
18
Q

Clinical signs for anemia, plus more specific symptoms:
including pica, restless legs, atrophic gastritis, and angular cheilosis

Microcytic anemia

Assess iron status with: serum ferritin, serum iron, TIBC

Supporting labs:
* Decrease in MCV (< 80 fL)
* Increase in TIBC (> 68 mmol/L)
* Increase in % of hypochromic RBCs (> 6%)
* Decrease in CRC (< 29 pg)

A

iron deficiency anemia

19
Q

what is important to remember to do with iron deficiency anemia

A

must determine reason for iron deficiency

r/o possible bleeding somewhere

20
Q

iron deficiency anemia treatment

A

dietary changes, oral supplements, IV iron

21
Q
  • Variants: X linked, recessive, toxic exposures, neoplasm
  • Bone marrow forms ringed sideroblasts instead of healthy
    erythrocytes
  • From abnormal iron use the heme isn’t formed properly
  • Can cause micro or macrocytic anemia, but usually microcytic
  • Normal to high iron levels
A

sideroblastic anemia

(can be a result of lead poisoning?)

22
Q

how to diagnose sideroblastic anemia

A

ringed sideroblasts from bone marrow—stain with Prussian blue stain

23
Q
  • Chronic inflammation causes iron sequestration and failure of heme
    synthesis
  • Chronic renal failure
  • Often normocytic early on then may become microcytic as it
    progresses
  • no rise in erythrocyte production in response to anemia
  • decreased Hgb, relic count, iron, and TIBC*
A

Anemia of chronic disease

24
Q

how to treat anemia of chronic disease

A

Treatment of anemia and underlying etiology as needed

25
Q

Most common causes:
Vitamin B12 deficiency*
Folate deficiency*
ETOH use
Liver disease

A

Macrocytic anemias

26
Q
  • autoimmune destruction of gastric parietal cells
  • leads to anemia from diminished synthesis of purines and pyrimidines
  • from gastrectomy, celiac disease, crohn’s
  • can cause neurologic and neuropsychiatric symptoms
A

B12 deficiency anemia

27
Q
  • microcytic anemia, with low reticulocyte count, thrombocytopenia, and hypersegmented neutrophils
  • low serum cobalamin
  • high serum methylmalonic acid (MMA) and homocysteine
A

B12 deficiency anemia lab results

28
Q

B12 treatments

A

cyanocobalamin (vitamin B12)

29
Q
  • leads to megaloblastic anemia from diminished synthesis of purines and pyrimidines
  • no neurologic symptoms
  • associated with fetal neural tube defects
A

folate deficiency anemia

30
Q
  • microcytic anemia, with low reticulocyte count, thrombocytopenia, and hyperhsegmented neutrophils
  • high serum LDH due to intramedullary destruction of megaloblastic precursors
  • low serum folate*
  • normal serum methylmalonic acid (MMA) and high serum homocysteine
A

folate deficiency anemia

31
Q

treatment of folate deficiency anemia

A
  • oral folic acid supplement
  • leucovorin (folinic acid)
32
Q

condition of bone marrow failure that arises from suppression of, and or injury to the hematopoietic stem cell. the bone marrow fails to produce mature blood cells and pancytopenia develops.

  • pancytopenia
  • no abnormal hematopoietic cells seen in blood or bone marrow
  • hypo cellular bone marrow
A

aplastic anemia

33
Q

hallmark of aplastic anemia

A

pancytopenia (neutropenia, anemia, and thrombocytopenia)

34
Q

treatment of aplastic anemia

A

mild cases: supportive care and erythropoietic or myeloid growth factors

severe cases young adults: bone marrow transplant

severe cases older adults: equine ATG

Heme/Oncology (9 decks)

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